CMS plans to begin displaying the first measure—which covers the last three days of a hospice patient’s life—on Hospice Compare in summer 2019 but will further test the second measure—which focuses on the last seven days of life—before any future display on Hospice Compare.

Hospice Visits when Death is Imminent is a pair of CMS hospice quality measures that assess hospice staff visits to patients at the end of life over 3 or 7 days.

• The first measure assesses the percentage of patients who receive at least one visit from a registered nurse, physician, nurse practitioner, or physician assistant in the last 3 days of life.
• The second measure assesses the percentage of patients receiving at least two visits from a medical social worker, chaplain or spiritual counselor, licensed practical nurse, or hospice aide in the last 7 days of life.

To allow further testing to determine if changes are needed to the seven-day measure or how it would be displayed on Hospice Compare, CMS is not publishing performance on that measure at this time. Additional testing will help ensure the measure’s accuracy and reliability as an indicator of provider quality. A fact sheet and Q&A document have been developed giving additional details about CMS’ decision-making process.

While the seven-day Hospice Visits when Death is Imminent measure will be reported on Certification and Survey Provider Enhanced Reporting (CASPER) QM Reports, it will not be publicly displayed on Hospice Compare at this time. The 7-day measure is calculated using items O5010, O5020 and O5030 from the Hospice Item Set (HIS) V2.00.0. Because the measure is not being removed from the Hospice Quality Reporting Program, providers are still required to complete these items accurately and completely and submit HIS records to CMS in a timely manner regardless of the decision to not publicly report the measure at this time.

Note that CMS is focusing on these end of life measures from the quality side of the hospice benefit but also the service intensity add-on from the payment side of hospice, as noted in the fiscal year 2019 final rule. We recommend that members providing hospice services continue to pay close attention to practice patterns at the end of life.